home Calculators Coronary heart disease (CHD) - symptoms, causes, types and treatment of CHD. Features of coronary heart disease: why it is dangerous, symptoms, how to treat the pathology Coronary changes in the blood vessels of the heart

Coronary heart disease (CHD) - symptoms, causes, types and treatment of CHD. Features of coronary heart disease: why it is dangerous, symptoms, how to treat the pathology Coronary changes in the blood vessels of the heart

Coronary heart disease (CHD) is a group of cardiac pathologies, which are based, first of all, on the discrepancy between how much oxygen the heart muscle needs for uninterrupted full functioning and how much oxygen is delivered to it. In all forms of ischemic disease, there is a disturbance in the blood supply to the myocardium due to spasm or changes in the lumen of the coronary arteries.

Coronary heart disease today affects about 6% to 15% of the population in different countries. This pathology is the first on the list of causes of death for the inhabitants of the planet. It accounts for about 35% of deaths from cardiovascular diseases.

Risk factors for coronary heart disease

To develop coronary artery disease, it is enough to have a type of blood flow in the heart that will not meet its metabolic needs, in which under-oxidized metabolic products will accumulate or the contractility of the myocardium will significantly weaken. The narrower the lumen of the heart arteries and the less productive the cardiac output, the higher the risks of developing this condition.

Men (due to hormonal characteristics) are more likely to develop ischemic heart disease than women; older people suffer from this disease more often than young people. After menopause The risks of men and women become equal after the latter reach menopause.
Disturbances in lipid metabolism (accumulation of LDL, decrease in HDL), leading to atherosclerosis of the coronary arteries, are the main risk in the development of cardiac ischemia.
Arterial hypertension, metabolic syndrome, diabetes mellitus, and abdominal obesity increase the risk of coronary artery disease.
Smokers and alcohol abusers are more likely to suffer from myocardial ischemia.
A sedentary lifestyle is also considered a risk factor.

Options for the development of ischemic heart disease

Angina - there is angina pectoris (new or stable), unstable angina, vasospastic angina
Sudden coronary death
Myocardial infarction
Post-infarction
Heart rhythm disturbances
Heart failure

What are the pains associated with coronary heart disease?

This is the most characteristic manifestation of the entire group of diseases. Pain occurs as a tissue response to the accumulation of under-oxidized metabolic products and the launch of a cascade of inflammatory mediators. The classic type of pain due to coronary artery disease is an attack of angina. The duration of a painful attack with stable angina pectoris does not exceed fifteen minutes. Pain of a compressive, less often pressing nature occurs in the projection of the heart () or behind the sternum (see).

Stable angina

The onset of pain in stable angina pectoris is associated with:

physical activity, that is, pain occurs during exercise and gradually subsides after its cessation
pain can be caused by smoking
psycho-emotional stress
alcoholic episode
sometimes even a rise in temperature
going out into the cold
or overeating

The intensity of pain during angina varies between moderate and quite intense, but does not reach the level of unbearable. The pain can radiate to the area of the left shoulder blade and under it, to the left hand or several fingers of the left hand. There is also a reflection of heart pain in the left half of the lower jaw. Rare irradiation - in the right hand.

The pain can be eliminated either by stopping physical activity or by taking Nitroglycerin in tablets, drops or spray (if you are intolerant to nitrates, you can use Sydnofarm - Molsidomin in a dose of 2 mg, that is, one tablet). Sometimes full-blown pain is replaced by a feeling of numbness in the chest or numbness in the little finger and ring finger of the left hand.

For stable angina, a classification is used that depends on the frequency of attacks and the conditions of their occurrence. Depending on the class, disease management tactics and drug support are selected.

1 functional class– attacks under loads exceeding the usual intensity or duration. Load resistance is high.
Class 2 – Pain with average normal loads (when walking more than 500 m, when climbing more than one floor). The risk of an attack due to non-physical activity is high.
Class 3 – Habitual physical activity is limited. Pain appears when walking further than 500 m, or when climbing one floor.
Grade 4 – Seizures are provoked by any minimal load, daily activities and self-care are limited. Angina at rest and attacks of pain when changing body position (when going to bed) are typical. It is impossible to walk even 100 m.

Unstable angina

Progressive angina— Unstable angina is characterized by a constant decrease in resistance to stress and a constant decrease in the threshold of load, which provokes pain. At the same time, the number of attacks of pain per week, day increases and their severity and duration increases. .

Angina at rest— Angina at rest is also considered unstable when there is no clear relationship between the occurrence of an attack of pain and physical activity; an attack of pain lasts longer than 15 minutes, but does not lead to necrosis of the heart muscle. This also includes angina pain that occurs for the first time or after a long interval between attacks. Over the course of a month, this type of angina will be considered new-onset angina. Since unstable angina is an intermediate option between stable angina pectoris and myocardial infarction, any episode of it requires immediate access to qualified medical care, additional diagnostics (ECG) and adequate therapy.

Variant angina against the background of spasm of the coronary vessels (Prinzmetal's angina) is also not associated with physical activity and more often causes pain in the early morning hours.

Post-infarction - Another variant of unstable angina, characterized by the resumption or appearance of attacks of angina pain in the period from 24 hours to 8 weeks after myocardial infarction. It can be provoked by early physical activity or insufficient drug support.

Acute myocardial infarction

The main and most common manifestation is also a pain syndrome similar to angina pectoris, but characterized by a greater severity of pain (from pressing and squeezing to burning), as well as duration and lack of relief when taking nitrates. Quite often the pain is accompanied by:

fear of death
autonomic symptoms such as sweating, dizziness
nausea, vomiting, abdominal pain.

The latter are characteristic of the abdominal form of a heart attack, which can occur under the guise of gastrointestinal problems. Often a heart attack is accompanied by collapse or painful shock in which the patient turns pale, gray and loses consciousness.

In the cerebral version of the infarction, it is cerebral circulatory disorders with loss of consciousness that precede chest pain.

It should also be mentioned painless form of myocardial infarction, in which the patient does not feel pain and sometimes suffers necrosis of the heart muscle “on his feet”. This type of infarction is often typical for the elderly with spontaneous sharp sclerosis of the heart vessels and for drinking patients. In this case, heart rhythm disorders or vascular collapse come to the fore.

Differential diagnosis of heart attack:

The basis for the differential diagnosis of acute myocardial infarction and prolonged anginal attack (lasting 20-30 minutes) remains the ECG.
In everyday conditions, it is worth focusing on the effectiveness of Nitroglycerin. So, for compressive pain in the heart area with or without irradiation, you can put a Nitroglycerin tablet under the tongue or spray it once with a spray (Nitromint) or use Molsidomin (Corvaton, Sidnopharm). If the pain does not go away within five minutes, the procedure is repeated. After waiting another five minutes, they take the third tablet and call an ambulance, since this is already a protracted attack of angina pectoris and, possibly, a heart attack.

A heart attack is the death of the heart muscle due to thrombosis (or narrowing) of a coronary vessel. Therefore, no blood flows beyond the location of the thrombus, and the pain cannot be completely relieved by the redistribution of blood between the layers of the myocardium, which is provided by nitrates. During a heart attack, pain can be relieved only by neuroleptoanalgesia (a combination of an anesthetic and a neuroleptic).

Pain due to heart rhythm disturbances

They are largely determined by the nature of the disorders and the severity of the circulatory disorder in the coronary vessels (and therefore the supply of oxygen to the heart muscle).

Rare single extrasystoles are felt as an extraordinary heartbeat followed by its freezing and further restoration of the usual heartbeats.
Frequent extrasystoles, double (bigymenia) or triple (trigymenia) may already cause stabbing, pulling, aching or even squeezing pain. The latter always speak of a myocardial nutritional disorder.
Paroxysmal tachycardia gives not only increased heart rate and pulse above 100, but also unpleasant pressing pain behind the sternum or in the heart area.
Atrial fibrillation gives an uneven spasmodic change in heartbeat. A feeling of lack of air, pressing or squeezing pain in the chest, fear of death, dizziness, may be accompanied by loss of consciousness.

Often, rhythm disturbances accompany myocardial infarction and are its complication. Therefore, any prolonged angina attack accompanied by heart rhythm disturbances requires calling an ambulance.

In addition to rhythm disturbances in the IHD program, they can occur with myocardiopathy, endocrine diseases, etc. If the patient is under 30 years old, it is always worth looking for alternative causes of arrhythmias to coronary artery disease. Therefore, in the presence of rhythm disorders, Holter ECG monitoring and ECHO-CS are always indicated. People over 45 are often prescribed MRI, which is fashionable today.

Dwelling on rhythm disturbances, it is worth noting that single extrasystoles or rare extrasystoles (up to 200 per day according to the results of daily ECG monitoring), despite the abundance of unpleasant sensations accompanying them, do not require drug treatment and do not threaten disorders of blood flow and nutrition of organs and fabrics.

Dyspnea

Shortness of breath is a symptom that feels like a lack of air, the inability to take a deep enough full breath. This type of shortness of breath is called inspiratory shortness of breath (as opposed to pulmonary expiratory shortness of breath with difficulty exhaling). Shortness of breath always indicates some degree of heart failure.

Dyspnea as equivalent to angina pain often confused with manifestations of circulatory failure. Such shortness of breath is not accompanied by a real shortening of the respiratory act. It stops when the factors that provoke the angina attack are eliminated and can be treated with nitroglycerin.
Dyspnea due to myocardial infarction– a consequence of acute circulatory disorder. The dead portion of the heart muscle reduces the ability of the myocardium to contract and push blood, which stagnates in the lungs. The plasma sweats into the lung tissue, and pulmonary edema of the interstitial or alveolar type develops. In addition to the feeling of lack of air and shortness of breath, hoarse breathing appears, which bubbles and can be heard at a distance, like heartbeats, and cold sweat. With alveolar edema, a significant amount of pinkish foam appears from the mouth.
Acute heart failure- if, against the background of a prolonged attack of intense chest pain, in addition to shortness of breath and a feeling of lack of air, the veins of the neck are inflated, the nasolabial triangle and limbs turn blue, pulsation appears in the epigastrium - a complication of a heart attack is likely, such as acute failure of the right ventricle of the heart.
Chronic heart failure manifests itself as shortness of breath with weakness of the right side of the heart. In this case, shortness of breath is combined with episodes of coughing with scant sputum. The patient has to sleep on a higher pillow, or even take a forced sitting position. Patients have pale bluish skin, bluish fingertips, and nasolabial triangle. Shortness of breath may give way to an episode of suffocation.

Edema

Also a sign of acute or chronic heart failure. They occur acutely with a heart attack, chronically - with cardiac arrhythmias, post-infarction cardiosclerosis. The most typical swelling is due to stagnation in the systemic circulation against the background of weakness of the left ventricle of the heart.

First, pastyness of the feet appears, which is replaced by swelling of the legs and legs, and as the process progresses, of the hips.
Subsequently, the genitals and the anterior abdominal wall swell. Massive swelling, called anasarca, may also develop.
A rapid increase in body weight (daily) indicates hidden edema located in the fatty tissue of the internal organs.
Swelling of the kidneys leads to a decrease in urine output.
Against the background of edema, the liver becomes large and dense, protrudes from under the costal arch and can hurt during exercise.
Swelling increases in the second half of the day and is difficult to respond to isolated treatment with diuretics.
Increasing stagnation of blood can create difficulties with cerebral circulation, which leads to memory, thinking, and sleep disorders.

Heart failure is divided into functional classes, which make it possible to assess resistance to stress, select therapy and make a prognosis for the future.

1 functional class allows you to tolerate the full volume of usual loads. Increased load is manifested by shortness of breath.
Class 2 gives shortness of breath or palpitations only during exertion (no manifestations at rest).
Class 3 – the appearance of manifestations with minimal loads and their absence at rest.
Grade 4 gives symptoms at rest.

Disorders of consciousness in ischemic heart disease

They range from:

mild dizziness and darkening of the eyes (various forms of arrhythmias and prolonged heart attacks)
to severe cerebrovascular accidents (heart failure and myocardial infarction) with loss of consciousness.

The lower the left ventricular ejection fraction, the longer the oxygen deprivation of the brain, the worse its condition, and the more unfavorable the prognosis. When systolic pressure is below 60 mmHg. The normal supply of oxygen to the brain stops and the person loses consciousness.

Various rhythm disturbances (sick sinus syndrome, atrioventricular block, ventricular tachycardia, ventricular fibrillation, Wolff-Parkinson-White syndrome) can cause fainting.

Among the interesting facts, it is worth noting that the infatuation with nitroglycerin without indications and its use for any stabbing pain in the chest can lead to drug-induced fainting, as well as cause severe headaches (which real “cores” are removed with validol).

In addition to disorders of consciousness, cortical ischemia is accompanied by:

sleep disorders (difficulty falling asleep, insufficient depth of sleep, early awakenings)
learning problems
mental disorders, the most striking of which is the overwhelming feeling of fear that is observed during acute myocardial infarction or an attack of atrial fibrillation.

A terminal disorder of consciousness can be considered clinical death during sudden coronary death, which, if resuscitation measures are unsuccessful, can lead to biological death.

Thus, the manifestations of coronary heart disease are diverse, but not unique to its different forms. Therefore, it is so important when they develop to contact a cardiologist for a more detailed diagnosis, and if life-threatening conditions develop, immediately call an ambulance.

Fedorov Leonid Grigorievich

Coronary heart disease is a common disease in which the flow of blood to the heart muscle is disrupted. Because of this, the organ suffers from a deficiency of oxygen and nutrients, its cells gradually die, and its functions are impaired. The acute form of the disease poses a serious danger to human health and life. It is important to consult a doctor at the first symptoms.

What is ischemic disease

The pathology is characterized by acute or chronic disruption of blood flow to the myocardium. A problem arises due to a lesion that impedes or completely disrupts the flow of arterial blood to the organ.

The acute form of the disease is. In chronic cases, ischemia is diagnosed.

Causes and risk factors

The development of ischemic disorders occurs under the influence of:

A person is able to influence most of these causes and reduce their negative impact on the body.

Types and forms

Cardiac ischemia can occur in different forms.

Painless

This condition is observed in people with a high pain threshold. It occurs during heavy physical labor, alcohol abuse, old age, and diabetes. The person does not feel severe pain, only minor discomfort is possible. Patients experience increased heart rate, angina, low blood pressure and weakness.

Primary cardiac arrest

It is also called sudden coronary death. Death occurs some time after the attack. This form is provoked by smoking, hypertension, and obesity. The patient develops ventricular fibrillation, from which he dies if help is not provided in time.

Angina pectoris

This type of ischemic disorder is accompanied by pressing, squeezing and burning pain in the chest, which can spread to other parts of the body. Patients feel nausea and intestinal colic. Discomfort is associated mainly with physical activity, overeating, and a sharp increase in pressure in the arteries.

The problem occurs during stress, hypothermia and other situations in which the myocardium’s need for oxygen increases.

Due to damaged arteries, not enough blood flows into the organ, causing pain. The attack lasts about 15 minutes. To alleviate the condition, you need to stop physical activity and take a Nitroglycerin tablet.

The disease occurs in a stable or unstable form. The first is caused by bad habits and excessive stress. The pain is relieved with nitrates. If there is no effect from Nitroglycerin, suspect. In this case, the risk of heart attack and death of the patient increases.

Unstable angina, in turn, happens:

First appeared. It is characterized by the appearance of attacks over the next few months. The condition worsens with emotional or physical stress. In this case, the condition of the coronary arteries is not impaired.
Post-infarction. If a person has suffered an attack of acute circulatory disorders, then after a few weeks he will experience signs of angina pectoris. The attacks may stop or develop into stable angina.
Progressive. In this case, the patient's condition gradually worsens, attacks occur more often, and the pain becomes more intense. There is shortness of breath and... As the disease progresses, minor stress is enough to cause an attack. The pain appears at night and intensifies during stress. Nitroglycerin does not bring relief. This form can have a different prognosis, but usually indicates the onset of a heart attack. Although sometimes health improves and remission occurs.

Myocardial infarction

This is how the acute form of ischemia manifests itself. It occurs during strong emotional experiences and physical exertion. In this case, the blood flow to a certain area of the heart completely stops. The condition may last for several minutes or hours. During this period, oxygen and nutrients do not reach the cells, causing them to die.

The patient suffers from severe chest pain and nitrates do not help alleviate the condition. A heart attack is not always associated with stress. Sometimes an attack occurs during sleep or in the morning.

A person suffers from nausea with vomiting, pain in the upper abdomen. Diabetics do not feel any symptoms - their attack proceeds unnoticed. It can be detected using an echocardiogram or echocardiography.

If there is a suspicion of a heart attack, the patient must be hospitalized immediately. He is prescribed medications and bed rest. Thanks to modern treatment methods, the rehabilitation period after a heart attack has been reduced several times.

Even if there are no symptoms, the patient needs to take medications throughout his life.

Cardiosclerosis

Ischemic disease also occurs in the form. As a result of the lack of blood supply, the tissue dies, and the foci of necrosis are replaced by connective tissue. The area with scar tissue does not contract, which leads to its hypertrophy and deformation of the valves. In this case, the heart’s ability to pump blood is impaired and heart failure develops.

Cardiosclerosis can be evenly distributed throughout the heart muscle or affects only certain areas. Usually the disease occurs after a heart attack. The pathology causes atherosclerotic deposits on blood vessels and inflammatory processes in the heart muscle.

The risk of developing the problem increases if you overeat, smoke, or exercise little. The pathological process occurs without any symptoms for a long time, so it is necessary to be examined periodically.

IHD occupies a strong leading position among the most common heart pathologies, often leads to partial or complete loss of ability to work, and has become a social problem for many developed countries of the world. A busy rhythm of life, constant stressful situations, adynamia, poor nutrition with consumption of large amounts of fat - all these reasons lead to a steady increase in the number of people suffering from this serious disease.

The term “coronary heart disease” combines a whole group of acute and chronic conditions that are caused by insufficient oxygen supply to the myocardium due to narrowing or blockage of the coronary vessels. Such oxygen starvation of muscle fibers leads to disturbances in the functioning of the heart, changes in hemodynamics and persistent structural changes in the heart muscle.

Most often, this disease is provoked by atherosclerosis of the coronary arteries, in which the inner wall of the vessels is covered with fatty deposits (atherosclerotic plaques). Subsequently, these deposits harden, and the vascular lumen narrows or becomes impassable, disrupting the normal delivery of blood to the myocardial fibers. From this article you will learn about the types of coronary heart disease, the principles of diagnosis and treatment of this pathology, the symptoms and what cardiologist patients need to know.

Currently, thanks to the expansion of diagnostic capabilities, cardiologists distinguish the following clinical forms of IHD:

primary cardiac arrest (sudden coronary death);
and spontaneous angina;
myocardial infarction;
post-infarction cardiosclerosis;
circulatory failure;
heart rhythm disturbances (arrhythmias);
painless ischemia of the heart muscle;
distal (microvascular) ischemic heart disease;
new ischemic syndromes (hibernation, stupefaction, metabolic adaptation of the myocardium).

The above classification of IHD refers to the International Classification of Diseases X system.

Causes

In 90% of cases, IHD is provoked by a narrowing of the lumen of the coronary arteries, caused by atherosclerotic changes in the walls of blood vessels. In addition, disturbances in the correspondence of coronary blood flow and the metabolic needs of the heart muscle can be a consequence of:

spasm of slightly changed or unchanged coronary vessels;
tendency to thrombus formation due to disorders of the blood coagulation system;
microcirculation disorders in the coronary vessels.

Risk factors for the development of such etiological causes of IHD may be:

age over 40-50 years;
smoking;
heredity;
arterial hypertension;
diabetes;
obesity;
increased levels of total plasma cholesterol (more than 240 mg/dl) and LDL cholesterol (more than 160 mg/dl);
physical inactivity;
frequent stress;
poor nutrition;
chronic intoxication (alcoholism, work in toxic enterprises).

Symptoms

In most cases, IHD is diagnosed already at the stage when the patient has its characteristic signs. This disease develops slowly and gradually, and its first symptoms become apparent when the lumen of the coronary artery narrows by 70%.

Most often, IHD begins to manifest itself as symptoms of angina pectoris:

a feeling of discomfort or discomfort that appears after physical, mental or psycho-emotional stress;
the duration of the pain syndrome is no more than 10-15 minutes;
pain causes anxiety or fear of death;
pain can radiate to the left (sometimes to the right) half of the body: arm, neck, shoulder blade, lower jaw, etc.
During an attack, the patient may experience: shortness of breath, a sharp feeling of lack of oxygen, increased blood pressure, nausea, increased sweating, arrhythmia;
the pain may disappear on its own (after stopping the exercise) or after taking Nitroglycerin.

In some cases, angina pectoris can manifest itself with atypical symptoms: it occurs without pain, manifests itself only as shortness of breath or arrhythmia, pain in the upper abdomen, and a sharp decrease in blood pressure.

Over time and without treatment, coronary artery disease progresses, and the above symptoms may appear at a significantly lower intensity of exercise or at rest. The patient experiences an increase in attacks, they become more intense and longer lasting. This development of coronary artery disease can lead to (in 60% of cases it occurs for the first time after a prolonged angina attack) or sudden coronary death.

Diagnostics

Making a diagnosis of suspected coronary artery disease begins with a detailed consultation with a cardiologist. The doctor, after listening to the patient’s complaints, always asks questions about the history of the appearance of the first signs of myocardial ischemia, their nature, and the patient’s internal sensations. An anamnesis is also collected about previous diseases, family history and medications taken.

After interviewing the patient, the cardiologist conducts:

pulse measurement and ;
listening to the heart with a stethoscope;
tapping the borders of the heart and liver;
general examination to identify swelling, changes in skin condition, the presence of venous pulsations, etc.

Based on the data obtained, the patient may be prescribed the following additional laboratory and instrumental examination methods:

ECG (in the initial stages of the disease, an ECG with stress or pharmacological tests may be recommended);
(daily monitoring);
phonocardiography;
radiography;
biochemical and clinical blood test;
Echo-CG;
myocardial scintigraphy;
transesophageal pacing;
catheterization of the heart and large vessels;
magnetic resonance coronary angiography.

The scope of the diagnostic examination is determined individually for each patient and depends on the severity of symptoms.

Treatment

Treatment of coronary artery disease is always complex and can be prescribed only after a comprehensive diagnosis and determination of the severity of myocardial ischemia and damage to the coronary vessels. These can be conservative (prescription of medications, diet, exercise therapy, spa treatment) or surgical techniques.

The need for hospitalization of a patient with coronary artery disease is determined individually depending on the severity of his condition. At the first signs of coronary circulation disturbance, the patient is advised to give up bad habits and follow certain rules of a balanced diet. When preparing your daily diet, a patient with coronary artery disease should adhere to the following principles:

reducing the amount of foods containing animal fats;
refusal or sharp limitation of the amount of table salt consumed;
increasing the amount of plant fiber;
introduction of vegetable oils into the diet.

Drug therapy for various forms of coronary artery disease is aimed at preventing angina attacks and may include various antianginal drugs. The treatment regimen may include the following groups of drugs:

In the initial stages of IHD, drug therapy can significantly improve health. Compliance with the doctor’s recommendations and constant medical observation in many cases can prevent the progression of the disease and the development of severe complications.

If conservative treatment is ineffective and there is extensive damage to the myocardium and coronary arteries, a patient with coronary artery disease may be recommended to undergo surgery. The decision on intervention tactics is always individualized. To eliminate the area of myocardial ischemia, the following types of surgical operations can be performed:

angioplasty of a coronary vessel with: this technique is aimed at restoring the patency of a coronary vessel by introducing a special stent (mesh metal tube) into its affected area;
coronary artery bypass grafting: this method allows you to create a bypass for blood to enter the area of myocardial ischemia; for this, sections of the patient’s own veins or the internal mammary artery can be used as a shunt;
transmyocardial laser revascularization of the myocardium: this operation can be performed if it is impossible to perform coronary artery bypass grafting; during the intervention, the doctor uses a laser to create many thin channels in the damaged area of the myocardium that can be filled with blood from the left ventricle.

In most cases, surgical treatment significantly improves the quality of life of a patient with coronary artery disease and reduces the risk of myocardial infarction, disability and death.

Educational film on the topic “Coronary heart disease”

According to various estimates, cardiac dysfunction occurs in every fifth to seventh person on the planet. The vast majority of patients have no idea that they are sick and need treatment. Hence the high percentage of mortality from coronary insufficiency, sudden arrest and myocardial infarction.

Cardiac ischemia is an acute or chronic disruption of nutrition and oxygen supply to the muscle layer. It forms the basis of a disease such as ischemic heart disease. It manifests itself in several ways.

According to the international classifier ICD-10, such a diagnosis does not exist. Objectively, the violation is represented by a group of conditions:

Arrhythmias.
Angina pectoris.
Acute decline in trophism (heart attack).
Failure (CHF).
Asystole (cardiac arrest).

IHD is a condition that is not expressed until a certain point. It can remain in the latent, sleeping phase for several years. As long as the body is able to compensate for ischemia, there will be no manifestations.

Then the picture grows like a snowball, unfolding literally in a few months, if not weeks. It is not difficult to determine pathology.

Treatment at the first stage is inpatient. Then it is corrected on an outpatient basis. Conservative (medication). The operations are ineffective.

In all cases of ischemia, a decrease in myocardial contractility is observed. As a result of a defect, overload due to increased blood pressure or other factors.

In terms of abstract consideration of pathogenesis, this is not so important. Because the heart is unable to beat normally, the amount of blood that is pumped into the aorta and circulated in a large circle drops.

This means that organs and tissues, including the myocardium itself, do not receive enough oxygen and useful compounds.

The process goes in cycles. If the root cause is not eliminated, contractility will not return to normal.

At the same time, even stopping the etiological factor will not return the heart to normal if organic changes have developed. They are already irreversible.

But there is a chance to compensate for the condition and forget about the pathology for many years, if not forever.

Coronary artery disease cannot be completely cured, but if the correct course of therapy is prescribed, the duration and quality of life do not differ from those of healthy people.

Forms of IHD

Pathology is divided on several grounds. The main thing is the type of process. The classification has already been mentioned above:

Angina pectoris.
Arrhythmia.
Heart attack.
HF (failure).
Coronary death.

Sometimes they also distinguish cardiosclerosis, scarring of an area of the myocardium and their loss from activity.

There are no specific manifestations. Typically, the pathology develops after a heart attack. The signs are identical to those of CHF (failure).

Another way to subdivide is to localize the violation:

Subendocardial myocardial ischemia. Weakening the nutrition of the inner layer of the heart muscle. It is considered a more severe condition. Has a slightly worse prognosis in terms of the likelihood of developing a heart attack. But this is not a guarantee.
Subepicardial form. The blood supply to the outer part of the muscle is disrupted.

There are no fundamental differences in therapy. Only diagnosticians can differentiate between the two types during examinations and ECGs.

Symptoms of myocardial ischemia

Symptoms of IHD directly depend on what form of ischemia develops. At the first stage, regardless of the further scenario, there are no signs at all. The patient is completely unaware.

The maximum that can hint at the development of a problem is an acceleration of the heartbeat after intense physical activity, mild burning pain in the chest that goes away in a matter of seconds. There are several options below.

Angina pectoris

It occurs in fits and starts. Each such episode is accompanied by characteristic moments:

Pain in the sternum of moderate or low intensity. Burning, pressing. There are almost no aching, pulling, much less sharp dagger ones. They occur suddenly or, more often, after physical exertion, stress, or hypothermia. They radiate to the left arm, shoulder blade, jaw, teeth, face in general, and also the neck. They last no more than half an hour and spontaneously regress. Taking Nitroglycerin is effective and completely relieves the unpleasant sensation.
Tachycardia. Also sudden. Increasing heart rate to 120-180 beats per minute. It has a sinus character in the early stages, so it does not pose a great danger. But it significantly reduces the quality of life. A characteristic sign of cardiac ischemia.
Fear, panic. A type of neurotic disorder. It does not develop in everyone, but in approximately 60% of patients with a repeated episode of angina or in 95% of patients with the first. Does not depend on gender and age. The patient is anxious at the onset of the attack and cannot find a place for himself. Excitement and increased motor activity are observed. As the condition normalizes, the panic attack is replaced by either restoration of mental status or stupor. But the violation does not last long, about 10-30 minutes.
Dyspnea. In a state of complete rest. Angina leads to the impossibility of normal gas exchange and a decrease in the contractility of the muscle layer. Hence the deviation of blood ejection into the pulmonary circle. The tissue is not saturated with O2, resulting in temporary disturbances.
Dizziness, cephalgia(pain in the back of the head, crown, temples), loss of consciousness, repeated fainting. They are relatively rare, more often with repeated episodes of the pathological process.

At the time of an acute condition, pallor of the skin and mucous membranes, cyanosis of the nasolabial triangle, weakness, drowsiness, and increased sweating are observed. Angina pectoris () lasts from several minutes to half an hour.

Heart attack

There are several differences. The main thing is that the pain is many times stronger or lasts over 30 minutes. Only a doctor can distinguish between both processes, and even then not immediately.

Arrhythmias of different types

They are considered symptoms in themselves. There are several types caused by ischemic processes in the cardiac layer.

. Stimulation of the natural pacemaker. A special accumulation of cells that are capable of independent excitation and creation of an electrical impulse. This in turn causes contraction of the entire myocardium.

Accelerating work leads to an increase in heart rate, but the pulse is usually correct, albeit frequent. Symptoms are minimal. Weakness, shortness of breath, impaired exercise tolerance.

or . The so-called atrial fibrillation or flutter. Caused by insufficient conductivity of heart structures as a result of low nutritional volume.

Whether it may occur immediately or later depends on the individual characteristics of the organism. Individual chambers begin to contract in their own rhythm. Contractility decreases.

Chaotic movements and lack of coordination lead to a reflexive stoppage of work and, most often, death.

Symptoms: shortness of breath, chest pain. The main thing is the feeling of fluttering, turning over in the chest, skipping, freezing.

Extrasystole. Usually group (by type, trigeminy). The occurrence of extraordinary beats that interfere with the normal rhythm.

There is a risk of cardiac arrest. It is detected relatively simply, an ECG is enough. Subjectively, it feels like extra contractions during the normal functioning of the organ, one after another.

Heart failure

The acute form manifests itself as a heart attack, but with predominantly arrhythmic symptoms, disruption of brain function (fainting, inability to orient in space, cephalgia and localization of pain in the back of the head).

Chronic makes itself felt with sluggish manifestations that progress as the pathological process develops:

Breathing disorders. Increase in the number of movements per minute.
Instability of blood pressure. Ups and downs, sometimes within one or two hours the indicator can change several times. This is fraught with stroke, acute cerebrovascular accident.
Arrhythmias. According to the type of bradycardia, decrease in heart rate.
Weakness, constant drowsiness. Asthenic manifestations are complemented by depression and constantly low mood.
Exercise intolerance. Shortness of breath and tachycardia occur.
Pale skin, cyanosis (blue discoloration) of the nasolabial triangle.

Manifestations are nonspecific. To delimit pathological processes, you need at least minimal medical knowledge.

Asystole

Develops in a matter of seconds. At the first moment, the patient feels heaviness in the sternum, shortness of breath, then loses consciousness.

If resuscitation is not carried out within a few minutes, it will be impossible to bring the person back.

There are no harbingers as such. Except for arrhythmias, which increase the risk of an emergency several times (not counting sinus tachycardia, it practically does not provoke cardiac arrest).

Differential diagnosis and how to distinguish one condition from another on your own?

Angina pectoris. The typical feature is moderate to mild chest pain lasting less than 30 minutes. Then the attack goes away on its own. Other diseases with ischemia do not give such a symptom at all.
During a heart attack, the pain never goes away on its own. It is many times stronger or the same, but lasts more than half an hour. Other points described above are also expressed.
is limited by the nature of the clinical picture. Arrhythmia of various types prevails. More often, a decrease in heart rate. As for pain, it almost never happens.

The chronic type of the process is not at all prone to an acute course. Clinical signs increase gradually: shortness of breath, rhythm disturbances, cerebral manifestations, and so on.

Symptoms of cardiac ischemia are not accurate diagnostic signs. To identify it, a group of events is carried out:

Oral questioning of the patient, collection of anamnesis. At a consultation with a cardiologist. The doctor is guided by the points presented above to estimate the nature of the problem.
Measurement of blood pressure and heart rate. The first indicator remains normal almost always, not counting heart failure and arrhythmic processes. The second is violated in all cases.
Auscultation. Does not give characteristic manifestations.
24-hour Holter monitoring. To assess vital signs over a 24-hour period.
Electrocardiography. The main technique for diagnosing and differentiating these pathologies.
Echocardiography. Ultrasound examination. Shows the consequences of a heart attack, angina, failure. Organic defects or acquired defects.
MRI if necessary.

In addition, differential diagnosis with non-cardiac pathologies is carried out. A chest x-ray (not fluorography), examination of the digestive tract (at least ultrasound), and assessment of the functional state of the spine (an indispensable method is MRI) may be required.

Silent myocardial ischemia will also be visible based on the results of instrumental studies. Most often, IHD in the early stages is an accidental finding.

Causes

The main development factors that can be identified during diagnosis:

Suffered a heart attack and eventually developed cardiosclerosis. Acute malnutrition of the heart muscle.
Arterial hypertension, especially if it lasts more than several years, in the second or third stages with a persistent increase in tonometer readings.
Defects of cardiac structures. Congenital and acquired.
Consumption of alcohol, smoking (especially long-term smoking), drugs, self-medication with antibiotics, antipsychotics, antidepressants, tranquilizers, estrogen oral contraceptives (birth control).
Age over 45 years and being male are risk factors.
Atherosclerosis. Blockage of the coronary arteries by cholesterol plaques, stenosis (narrowing) of blood vessels.
Diabetes.
Hyper- or hypothyroidism. Inadequate production of thyroid hormones.

Family history also plays a role. Many metabolic disorders are genetic. The causes of ischemia are metabolic abnormalities, vascular and cardiac problems.

Treatment

Therapy is carried out in the cardiology department or on an outpatient basis if the severity of the condition is not present. The basis is the use of medications.

It is important to solve three problems: eliminate the root cause of the pathological process, relieve symptoms, and prevent complications. The directions are implemented in different ways, only the latter is integrated into the previous two.

Combating the root cause involves prescribing drugs from several groups:

Statins. They dissolve cholesterol plaques and remove lipid structures from the body. Necessary to fight atherosclerosis. The most popular remedy is Atoris.
Thrombolytics. They prevent blood clots from forming and normalize the fluidity of connective tissue. Heparin or Aspirin-Cardio.
Antihypertensive. From ACE inhibitors and calcium antagonists to centrally acting drugs. Normalizes blood pressure.
Beta blockers. They lower blood pressure and restore rhythm, and reduce the increase in heart rate.
Cardioprotectors. They protect the heart from negative influences and also improve myocardial nutrition. Mildronate.
Products based on magnesium and potassium (Asparkam and others).

Symptomatic medications:

Antiarrhythmic. According to indications, they are considered heavy drugs and are not suitable for long-term use. Used by courses. At the discretion of the specialist. Amiodarone or Quinidine as the main ones.
Beta blockers. Anaprilin, Metoprolol, Carvedilol.

Cardiac glycosides are not prescribed.

The cause of the development of myocardial ischemia may also be a defect or anatomical defect. The septum and valves (tricuspid, aortic or mitral) are most often affected. In this case, surgery cannot be avoided.

The operation consists of prosthetic replacement of the affected area. Less commonly, plastic surgery, restoration of anatomical shape and tissue integrity. But this almost never brings results. Replacement is preferable.

Throughout your entire life you must adhere to a number of restrictions. Pills alone are not enough.

Most often, IHD and myocardial ischemia in general are chronic conditions that can be corrected and compensated, but are never completely eliminated.

Quitting smoking and alcohol.
Diet correction. Minimum fat, fried, smoked, semi-finished products, pickles, tonic drinks. Salt up to 7 grams per day. But at least 3-4. Treatment table No. 10 is indicated or, better, a consultation with a nutritionist and the appointment of an individual diet.
Get proper rest for at least 7-8 hours per night.
Walking in the fresh air and lack of movement increases risks.

All questions should be discussed with your doctor, and you should clarify with him the nature of the restrictions.

Forecast

Depends on the moment of detection, the degree of functional and organic disorders of the cardiac structures, and the quality of the prescribed treatment.

If there are no dangerous forms of arrhythmia, there is no history of necrosis - favorable.

The presence of manifestations of the brain, previous heart attack, stroke, late detection are accompanied by a worse prognosis.

But in general, treatment even at advanced stages gives good results and allows you to live a long, quality life. It is important not to delay visiting a cardiologist.

It is better to address questions and clarifications to a leading specialist (therefore, it would be a good idea to contact the same doctor).

Consequences and complications of coronary artery disease

Among the negative results of the pathology:

Heart attack.
Heart failure.
Vascular dementia. Similar to Alzheimer's disease, but potentially reversible.
Stroke. Necrosis of brain tissue.
Death as a result or disability.

Death does not occur overnight. It takes years for coronary disease to form, not counting only a heart attack, which destroys health in one moment.

The consequences of myocardial ischemia are lethal; preventing complications is the goal of therapy.

Weakening of the nutrition of the heart muscle and coronary artery disease as a characteristic syndrome are the results of third-party processes. Treatment is planned or urgent, depending on the case. The forecasts are generally good. It is important not to miss the moment.

is a disease that is a violation of the blood circulation of the myocardium. It is caused by a lack of oxygen, which is carried through the coronary arteries. Manifestations of atherosclerosis prevent its entry: narrowing of the lumens of blood vessels and the formation of plaques in them. In addition to hypoxia, that is, lack of oxygen, tissues are deprived of some of the beneficial nutrients necessary for the normal functioning of the heart.
Coronary artery disease is one of the most common diseases that causes sudden death. It is much less common among women than among men. This is due to the presence in the body of representatives of the fairer sex of a number of hormones that prevent the development of vascular atherosclerosis. With the onset of menopause, hormonal levels change, so the possibility of developing coronary artery disease increases sharply.

Within the classification of coronary heart disease, the following forms are distinguished:

Painless form. This myocardial ischemia is typical for people with a high pain threshold. Its development is promoted by hard physical labor and alcohol abuse. Elderly people and sick people are at risk. This form of ischemia is painless, which is why it is often called silent. However, in some cases, chest discomfort may occur. It occurs in the early stages of the disease. Characteristic symptoms of silent cardiac ischemia are tachycardia, angina pectoris, and severe. Possible weakness in the left arm, shortness of breath or.

Primary cardiac arrest. It refers to sudden coronary death. It occurs immediately after a heart attack or within a few hours after it. This manifestation of coronary heart disease is promoted by excess weight, smoking, arterial hypertension, and the cause is ventricular fibrillation. Sudden coronary death with successful resuscitation or ending in death is distinguished. In the first case, qualified medical assistance must be provided immediately. If defibrillation is not done on time, the patient dies.

Compressive or pressing pain, discomfort in the chest area - these are the main symptoms by which this form of coronary artery disease is determined. It often manifests itself in the form of heartburn, colic or nausea. Pain from the chest can radiate to the neck, left arm or shoulder on the same side, sometimes to the jaw and back areas. Discomfort occurs during active physical activity, after eating, especially when overeating, and a sharp increase in blood pressure. Angina pectoris is caused by stress and hypothermia. In all these situations, there is a need for more oxygen to the heart muscle, but due to the clogged arteries, this is not possible. To cope with the pain, which can last up to 15 minutes, it is enough to stop physical activity if it was caused by it or take short-acting nitrates. Nitroglycerin is considered the most popular among these drugs.

Angina can be stable or unstable. In the first case, it is caused by the action of environmental factors: smoking, significant physical activity. You can cope with it with the help of nitroglycerin. If it becomes ineffective, this indicates the development of unstable angina. It is more dangerous, as it often causes myocardial infarction or death of the patient. One type of unstable angina is new-onset angina. The main distinguishing feature of this form of the disease is that the onset of attacks began no later than several months ago. The cause of new-onset angina can be severe emotional or physical stress. In this case, the coronary arteries can function normally. The second group of patients consists of patients who have suffered and have pathology of the coronary arteries. If the disease develops unnoticed, there is a high probability that it will develop into stable angina. But another option is also possible. Often, the first symptoms soon disappear, the attacks stop, and over the next few years the patient does not experience any symptoms of angina. At the same time, regular examinations are required to prevent unexpected myocardial infarction.

Cardiosclerosis can be diffuse and focal. In the first case, scar tissue replaces heart cells evenly, distributed throughout the muscle. With focal cardiosclerosis, the connective tissue affects only certain areas. It is usually caused by myocardial infarction.

Plaques in the arteries cause the development of atherosclerotic cardiosclerosis. The development of myocardial cardiosclerosis is promoted by the inflammatory process directly in the heart muscle. Overeating, smoking, and a sedentary lifestyle increases the risk of developing the disease. For a long time, cardiosclerosis can be asymptomatic, especially in the case of atherosclerotic form. During rehabilitation and prevention, patients should follow a diet that involves minimal consumption of salt, fats and liquids.

There are several main symptoms of cardiac ischemia:

Pain in the chest and behind the chest area. It may have a stabbing, burning or squeezing character. Unpleasant sensations arise unexpectedly and pass after 3-15 minutes. In the first stages of coronary artery disease, discomfort may be mild. Severe pain radiates to the left arm and shoulder, less often to the jaw and right side. They appear during sports, or under strong emotional stress. To get rid of discomfort resulting from physical activity, it is enough to take a short break. When such measures do not help and the attacks become severe, they resort to the help of medications.

Dyspnea. Like pain, it first appears during movement and is caused by a lack of oxygen in the body. As the disease progresses, shortness of breath accompanies each attack. The patient experiences it even at rest.

Heartbeat disorders. It becomes more frequent, and in this case the blows are felt more strongly. There may also be interruptions at some points. The heartbeat is felt very weakly.

General malaise. The patient experiences, may fall into, quickly gets tired. There is increased sweating and nausea, leading to vomiting.

In the old days it was called “angina pectoris”. This phrase is not accidental, because angina pectoris is not pain, but severe squeezing and burning in the chest and esophagus. May be felt in the form of pain in the shoulder, arm or wrist, but such cases are less common. Angina pectoris can easily be confused with heartburn. It is not surprising that some people try to cope with it and use soda to do it. In cardiology, angina is considered the most striking symptom, indicating the presence of ischemic heart disease and helping to prevent myocardial infarction. It is much worse when the disease occurs without external manifestations. The asymptomatic form is fatal in most cases.

During a heart attack, the lumen of the arteries is completely blocked by plaques. The pain increases gradually and after half an hour becomes unbearable. The discomfort may not go away for several hours. In the chronic form of coronary heart disease, the lumen of the vessel is not completely blocked, and the attacks of pain are less prolonged.

Psychological symptoms. During a heart attack, the patient may experience inexplicable fear and anxiety.

The main reasons that can cause cardiac ischemia are as follows:

Atherosclerosis. The myocardium is surrounded by two main arteries, through which blood flows to the heart. They are called coronary and branch into many small vessels. If the lumen of at least one of them is partially or completely closed, certain parts of the heart muscle do not receive the necessary nutrients, and most importantly, oxygen. There are no more arteries supplying the heart with blood, so its work is disrupted and coronary artery disease develops.

Arterial blockage occurs due to a condition that affects the arteries. It involves the formation of cholesterol plaques in the arteries that prevent blood from moving. Performing active movements with a lack of oxygen in the heart muscle is accompanied by pain.

At this stage, coronary disease is expressed in the form of angina pectoris. Gradually, myocardial metabolism worsens, pain intensifies, becomes longer lasting and appears at rest. Heart failure develops, the patient suffers from shortness of breath. If the lumen of a coronary artery suddenly becomes blocked as a result of plaque rupture, blood stops flowing to the heart and a heart attack occurs. As a result, death is possible. The patient's condition after a heart attack and its consequences largely depend on the blockage of the artery. The larger the affected vessel, the worse the prognosis.

Poor nutrition. The cause of the formation of plaques on the walls of blood vessels is excess cholesterol in the body, which comes from foods. In general, this substance is necessary, as it is used to create cell membranes and produce a number of hormones. It is deposited on the walls of blood vessels under the influence of stressful situations.

Emotional stress causes the production of a special substance. This, in turn, promotes the sedimentation of cholesterol in the arteries. A properly formulated diet can reduce its amount in the body. It is worth limiting the consumption of foods that contain saturated fats: butter, sausage, fatty cheeses and meats. It is recommended to give preference to fats contained in fish, nuts, and corn. Quickly digestible and high-calorie foods contribute to the development of cardiac ischemia.

Bad habits. Alcohol abuse and smoking affect the functioning of the heart muscle. Cigarette smoke contains a large number of chemicals, including carbon monoxide, which impedes the transport of oxygen, and nicotine, which increases blood pressure. In addition, smoking affects the formation of blood clots and the development of atherosclerosis.

Sedentary lifestyle or excessive exercise. Uneven physical activity creates additional stress on the heart. The cause of ischemia can be both physical inactivity and physical activity that exceeds the body’s capabilities. It is recommended to exercise regularly, individually determining the intensity, duration, and frequency of training.

Obesity. Numerous studies have revealed a direct relationship between excess weight and mortality from cardiovascular diseases. Therefore, it is one of the factors contributing to the development of ischemia.

Diabetes. The risk of developing coronary heart disease is high for patients with type I and type II diabetes mellitus. They need to normalize carbohydrate metabolism to reduce risks.

Psychosocial reasons. There is an opinion that people with higher social status and education are less susceptible to coronary disease.

Diagnosis of coronary artery disease is carried out primarily on the basis of the patient’s sensations. Most often they complain of burning and pain in the chest, shortness of breath, increased sweating, and swelling, which is a clear sign of heart failure. The patient experiences weakness, heartbeat and rhythm disturbances. It is mandatory to perform electrocardiography if ischemia is suspected. Echocardiography is a research method that allows you to assess the condition of the myocardium, determine muscle contractile activity and blood flow. Blood tests are performed. Biochemical changes can reveal coronary heart disease. Carrying out functional tests involves physical activity on the body, for example, walking up the stairs or doing exercises on a machine. In this way, heart pathologies can be detected in the early stages.

To treat ischemia, the following groups of drugs are used in combination: antiplatelet agents, adrenergic blockers, fibrates and statins. Specific remedies are selected by the doctor depending on the form of the disease. Antiplatelet agents improve blood flow; with the help of adrenergic blockers, it is possible to reduce the frequency of contractions of the heart muscle and reduce oxygen consumption. The action of fibrates and statins is aimed at atherosclerotic plaques. The drugs reduce the rate of their appearance and prevent new formations on the walls of blood vessels.

The fight against angina is carried out with the help of nitrates. Natural lipid-lowering drugs are also widely used for the treatment of coronary disease. Anticoagulants influence the formation of blood clots, and diuretics help remove excess fluid from the body.

Since plaques in the vessels cause their narrowing, it is possible to artificially increase the lumen in the coronary arteries. For this purpose, stenting and balloon angioplasty are performed. During these bloodless surgical interventions, the lumen in the vessels expands and blood flow is normalized. These methods have replaced traditional bypass surgery, which today is performed only for some forms of coronary artery disease. During this operation, the coronary arteries are connected to other vessels below the site of the disturbance in the blood flow in them.

In addition to drug treatment and general therapy, the patient needs moderate physical activity. Depending on the form of ischemia, a set of exercises is developed by the doctor. After all, excessive physical activity increases the oxygen demand of the heart muscle and has a negative impact on the development of the disease.

If you have an unexpected attack while walking or playing sports, you should stop and rest, take a sedative and go out into the fresh air. Then you should take a nitroglycerin tablet.

This drug takes effect within 5 minutes. If the pain does not go away, you need to take 2 more tablets. The ineffectiveness of nitroglycerin indicates serious problems, so if there is no improvement in your condition, you should urgently go to the hospital. Prevention of coronary heart disease involves avoiding alcohol consumption, smoking, proper balanced nutrition and regular exercise. It is necessary to monitor and control your weight. The presence of positive emotions and the absence of stress is important.

The basic principles of the diet for ischemia are as follows:

Patients with coronary artery disease will have to minimize salt, sugar, candies and sweets, confectionery, that is, all sources of simple carbohydrates, fatty meat, caviar, spicy and salty foods, chocolate, coffee and cocoa in their diet.

The most important thing is to limit the consumption of foods containing large amounts of cholesterol and fat. You need to eat little, but often.

You should definitely eat foods that contain ascorbic acid, A, B, C, potassium, and calcium.

Vegetable oil used for cooking should be replaced with corn and olive oil. It is much healthier, and also contains fatty acids that have a positive effect on blood circulation.

The diet should be dominated by dairy products, with the exception of butter, cereals, seafood, vegetable soups, low-fat sea fish, for example, cod, egg white omelet, turkey, chicken.

It is recommended to steam the dishes. In addition, products can be boiled or stewed.

Below is the usual menu for 7 days for patients with cardiac ischemia:

Monday

Breakfast – a slice of whole grain bread, a glass of weak tea without sugar

Lunch – vegetable salad, a piece of boiled skinless chicken, rice, a glass of fruit juice

Dinner – cottage cheese casserole without sugar, a glass of kefir

Tuesday

Breakfast – omelet with several proteins, apple, tea

Lunch – baked potatoes, steamed cod, a slice of rye bread, tea

Dinner – vegetable stew, unsweetened yogurt

Wednesday

Breakfast – oatmeal, fruit juice

Second breakfast – cottage cheese with fruit

Lunch – vegetable salad dressed with olive oil, baked turkey, tea

Dinner – milk soup, tea

Thursday

Breakfast – boiled egg, a slice of whole grain bread, natural yogurt

Second breakfast – apple

Lunch – baked chicken, buckwheat, tea

Dinner – vegetable soup, a glass of kefir

Friday

Breakfast – oatmeal, apple, juice

Second breakfast – a glass of kefir

Lunch – soaked herring, baked, tea

Dinner – vegetable salad dressed with olive oil, a glass of milk

Saturday

Breakfast – cottage cheese casserole with fruit, tea

Second breakfast – natural yogurt

Lunch – boiled sea bass, vegetable salad, glass of milk

Dinner – milk soup, tea

Sunday

Breakfast – millet porridge, natural yogurt

Second breakfast - white omelet

Lunch – turkey and baked potatoes, tea

Dinner – vegetable soup, a glass of kefir

Education: In 2005, she completed an internship at the First Moscow State Medical University named after I.M. Sechenov and received a diploma in the specialty “Neurology”. In 2009, she completed her postgraduate studies in the specialty “Nervous Diseases”.